Provider Demographics
NPI:1770785602
Name:SEABROOK CHIROPRACTIC & WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:SEABROOK CHIROPRACTIC & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:603-474-9990
Mailing Address - Street 1:727 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03874-4255
Mailing Address - Country:US
Mailing Address - Phone:603-474-9990
Mailing Address - Fax:
Practice Address - Street 1:727 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:NH
Practice Address - Zip Code:03874-4255
Practice Address - Country:US
Practice Address - Phone:603-474-9990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH111-1092111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE3122Medicare ID - Type Unspecified